Hair Mineral Test - Research

Pre- and Post- Menstrual Syndrome

Dr David L. Watts, Director of Research

Pre-menstrual syndrome (PMS) has become a very well known condition within the last several years. This term is often loosely applied to women who develop physical and emotional changes near, or during menstruation. It is also common, but less so, for some to develop various symptoms following their menstruation - this is termed post-menstrual syndrome.

It is now becoming more accepted that abnormalities in the menstrual cycle are usually caused by a hormonal imbalance, primarily between progesterone and oestrogen. However, other endocrine glands are also involved, such as the thyroid, adrenals, and pituitary, a matter to be discussed in future issues.

Recent research reveals that nutritional imbalances can play an important role in PMS. A double-blind longitudinal study of women suffering from PMS was reported by researchers for John Hopkins Health System. They found significant improvements of PMS symptoms in women who took nutritional supplements compared to those who took no supplements. A study reported by Baylor Medical College found that women have an abnormally low zinc level during their symptomatic PMS phase. Their study suggests that zinc is necessary for the secretion of progesterone, and that too little zinc causes a drop-off of progesterone during PMS, and alters brain chemistry such as endorphin production. Hair tissue mineral analysis (TMA) can reveal long-term element imbalances which can provide clinical groundwork for safe, specific, and targeted nutritional therapy.

Pre-menstrual's Impact of zinc and copper

Copper is well recognised for its association with oestrogen while zinc, on the other hand, is associated with progesterone. Hair TMA studies have shown that the majority of women who experience pre-menstrual syndrome show an elevated tissue copper level (>3.5 mg%) and/or a markedly low zinc-to-copper ratio (<4.00). This particular mineral balance often indicates a low progesterone-to-oestrogen ratio. Many women taking oral contraceptives have elevated tissue copper levels. The same is true for women using copper intrauterine devices, since the body absorbs the copper from the copper wire. Many gynecologists believe that this copper absorption is the mechanism of pregnancy prevention. An imbalance between the hormones oestrogen and progesterone, as well as zinc, copper and other nutritional factors, is likely to be the chief culprit contributing to menstrual abnormalities.

Women with this condition frequently develop pre-menstrual problems as oestrogen levels will normally rise markedly prior to menstruation. An imbalance in these women produce symptoms similar to those of copper toxicity: frontal headaches, constipation, fatigue, depression, volatility, weight gain, and food cravings. Usually women who have excessively high tissue copper will have heavy and prolonged menstrual flow. Symptoms may vary from individual to individual depending upon the degree of copper toxicity and will subside during or after menstruation, since progesterone then begins to rise and counteract the effect of oestrogen. However, if her zinc levels predominate, she may have a light and short menstrual flow, and her breasts may become extremely tender. Too much copper, on the other hand, can also stop menstruation. Patients with anorexia nervosa typically stop menstruating. Our laboratory research commonly find very high issue copper levels in patients suffering from anorexia and bulimia.

"Even if serum (or blood) markers indicate that maternal nutrition is adequate, the hair markers should also be looked at because they may show an opposite trend and these reflect an overall nutritional status of the subject."

Post-menstrual's Impact of zinc and copper

Post-menstrual syndrome is due to opposite factors wherein there may be high progesterone level relative to oestrogen. This translates into an elevated tissue zinc-to-copper ratio (> 12.00). Often these women will feel much better premenstrually when oestrogen and copper levels are rising as oestrogen will counteract the effects of too much progesterone. However, following menstruation as oestrogen levels decrease, they may develop symptoms of anxiety, defensiveness, indecision, agitated depression, and water retention. This type of hormonal imbalance usually results in short and light menstrual flow with extreme breast soreness.

Abraham G.E. reported that magnesium deficiency in the erthrocytes of women is also believed to play an important role in provoking symptoms of PMS. In his classic study on nutrition and PMS, Abraham associated PMS-H, a premenstrual condition characterized by fluid retention, weight gain, swelling, and bloating, with a synergistic imbalance causing magnesium deficiency and elevated aldosterone levels.

Walker A.F. et al. studies have shown that many women with this type of PMS may benefit from magnesium supplementation, which can alleviate symptoms such as mood swings and fluid retention.

Hormonal Imbalances and Pregnancy

It is not uncommon to find that when some women become pregnant, they feel much better both physically and emotionally. Most likely, these are women who were progesterone dominant relative to oestrogen prior to pregnancy. During pregnancy, oestrogen levels rise dramatically reaching their highest point during the last trimester. For these women pregnancy and the resulting increase in oestrogen contributes to an improvement in the hormonal imbalance. On the other hand, some women feel worse while pregnant, especially if they had high oestrogen levels before pregnancy. Too much oestrogen and copper are associated with more complications during pregnancy. Women with high tissue copper levels on their hair TMA commonly suffer from toxemia during pregnancy, and post-partum depression. Endometreosis is another condition found in women with high tissue copper.

Toxemia and Post-Partum Depression

After delivery, the mother's copper levels returns to normal. Some women however remain high in copper long after they have delivered. The reason may be due to the development of gallstones during pregnancy. Pregnancy increases the susceptibility to gallstones several-fold and therefore results in the inability to excrete the mineral. Copper toxicity can become a real problem if pregnancies are close together. What worse, increased copper accumulation in the mother can lead to inherited copper toxicity in the children. 
Some women actually feel much better once they conceive. If this occurs, they probably had more progesterone (zinc) than oestrogen (copper) in their systems before the pregnancy. Conversely, women who feel terrible while carrying a baby probably started with too much oestrogen and copper accumulated within the body tissue. The pregnancy increased those already high amounts, exacerbating the situation.

Huang HM et al. at the City University of Hong Kong, published "hair and serum calcium, iron, copper and zinc levels during normal pregnancy at three trimesters". The hair and serum levels of calcium, iron, copper and zinc levels were measured in a group of 70 healthy pregnant women and in 66 age-matched healthy controls living in the Tianjin city of the People Republic of China. The study subjects were classified into three subgroups according to gestational age. The study found that the hair concentrations of Ca, Fe, Cu, and Zn in the three groups of gravida were significantly lower than those in controls. In sera, the differences did not show statistical significance in most cases. A deficiency of calcium was observed in subjects in the last trimester of gestation which reinforces the importance of supplementation with calcium during pregnancy.

The study suggested that maternal diets should be diversified and adapted according to the development of gestation. Even if serum (or blood) markers indicate that maternal nutrition is adequate, the hair markers should also be looked at because they may show an opposite trend and these reflect an overall nutritional status of the subject.

Biol Trace Elem Res, 69(2):111-20, 1999

As mentioned previously, the tissue zinc to copper ratio can be applied to the progesterone-to oestrogen ratio respectively. Those who develop premenstrual symptoms are usually found to have a low zinc to copper ratio, which is indicative of a copper excess. Supplementation with zinc and vitamin B6 can aid in reducing the effects of PMS and copper excess. If no improvements are noted with zinc and B6 alone, then magnesium, additional B vitamins, and glandular support may also be needed. Often zinc and B6 will control some of the common symptoms of PMS quite well, especially the frontal headaches. For those with post-menstrual syndrome or a high zinc-to-copper ratio, copper is the nutrient of choice following menstruation.


  1. Watts D.L.: Pre- and Post Menstrual Syndrome TEI Newsletter 3:4, 1995.
  1. Watts D.L.: The Nutritional Relationships of Zinc. J Ortho Med 3:2, 1989.
  2. Watts D.L.: The Nutritional Relationships of Copper. J Ortho Med 4:2, 1989.
  3. Huang H.M., Leung P.L., Sun D.Z., Zhu M.G.: Hair and Serum Calcium, Iron, Copper, and Zinc Levels During Normal Pregnancy at Three Trimesters. Biol Trace Element Res 69:1999.
  4. Abraham G.E.: Nutritional Factors in the Etiology of the Prementrual Tension Syndromes. J Reprod Med 28(7):446-64, 1983.
  5. Walker A.F., De Souza M.C., Vickers M.F., Abeyasekera S., Collins M.L., Trinca L.A.: Magnesium Supplementation Alleviates Premenstrual Symptoms of Fluid Retention. J Women Health 7(9):1157-65, 1998.